Copyright © 1998 by the European Society of Cardiology.
Long-term prognosis in unstable angina. The importance of early risk stratification using continuous ST segment monitoring
Department of Cardiology, Royal Brompton Hospital, London, U.K.
accepted June 9, 1997
Aims
To assess the ability of clinical characteristics, ad-mission ECG and continuous ST segment monitoring in determining long-term prognosis in unstable angina.
Methods
Two hundred and twelve patients with unstable angina (mean age 59 years), presenting within 24h of an acute episode of angina were recruited at three hospitals and treated with standardized medical therapy. All patients kept chest pain charts and underwent ST segment monitoring for 48h. The occurrence of death, myocardial infarction, and need for revascularization was assessed over a median follow-up of 2·6 years.
Results
The risk of death of myocardial infarction was greatest in the first 6–8 weeks after admission. Admission ECG ST depression and the presence of transient ischaemia predicted increased risk of subsequent death or myocardial infarction, whereas a normal ECG predicted a good prognosis. In 14 patients, ST segment monitoring provided the only evidence of recurrent ischaemia, and 72% of this group suffered an adverse event. Transient ischaemia and a history of hypertension were the most powerful independent predictors of death or myocardial infarction.
Conclusions
Adverse events in unstable angina occur early after admission and can be predicted by clinical and ECG characteristics, and by the presence of transient ischaemia during ST segment monitoring. Risk stratifi-cation by these simple assessments can identify patients with unstable angina at high risk.
Key Words: Unstable angina • prognosis • transient ischaemia • ST segment monitoring
f1 Correspondence: Dr Deven J. Patel, Department of Cardiology, Harefield Hospital, Hill End Road, Harefield, Middlesex UB9 6JH, U.K.
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